ArticleNeurocritical care2026
Effect on Mortality of Anticoagulant Reversal in Acute Intracranial Hemorrhage: A Systematic Review and Meta-analysis.
Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
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Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundReversal treatment is used to counterbalance effects of oral anticoagulation in intracranial hemorrhages. Despite effects on reducing hematoma expansion, the impact on mortality remains uncertain. Our aim was to assess the effects of reversal treatment on mortality in various forms of oral anticoagulant-associated intracranial hemorrhage.
methodsSystematic searches were performed in the electronic databases of PubMed, Embase, Scopus, and Web of Science from database inception to March 2025. We included studies that compared mortality between patients receiving reversal treatment vs. non-reversal in oral-anticoagulant-associated intracranial hemorrhages. Only studies with appropriate statistical controlling for significant confounding variables were included. Data extraction and synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Data were summarized and pooled effect estimates were presented. Outcome was mortality, and primarily with a follow-up limited to 3 months.
resultsA total of 8217 studies were screened; 8 were ultimately included, all observational, and including 8777 participants with documented reversal treatment. For the overall analysis, when all types of intracranial hemorrhage and all types of anticoagulants were included, reversal was associated with reduced mortality (RR 0.78 (95% CI 0.67-0.91); p = 0.002). This association was also seen in the subgroup analysis of 8639 participants with nontraumatic intracerebral hemorrhage on any oral anticoagulant (RR 0.77 (95% CI 0.64-0.94); p = 0.009), but not among the 3059 participants with intracerebral hemorrhage treated with only direct oral anticoagulants (RR 0.91 (95% CI 0.80-1.03); p = 0.15).
conclusionsCurrent evidence for reduced mortality following anticoagulant reversal in intracranial hemorrhage is limited and primarily derived from observational studies. Although pooled data suggest a potential treatment benefit across various types of intracranial hemorrhages and anticoagulants, most hemorrhage subtypes remain insufficiently studied. Going forward, there is a critical need for randomized clinical trials and additional well-controlled observational studies to determine which patients truly benefit from reversal treatment.
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